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CHILDHOOD  AND  GROWTH 


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CHILDHOOD  AND   GROWTH 

A  PAPER  READ  OCTOBER  6TH,  1905,  BEFORE 
THE  NEW  HAVEN  MOTHERS'  CLUB 


BY 
LAFAYETTE   B.  MENDEL 

PROFESSOR  OF  PHYSIOLOGICAL  CHEMISTRY  IN  THE  SHEFFIELD 

SCIENTIFIC  SCHOOL  OF  YALE  UNIVERSITY 

NEW  HAVEN,  CONNECTICUT 


WITH    AN    INTRODUCTION 


HORACE    FLETCHER 


^OFTHfc       ^ 

UNIVERSITY 


NEW  YORK 

THE  FREDERICK  A.  STOKES  COMPANY 

MCMVI 


4 


f%' 


Copyright,  igos 
By  Horace  Fletcher 


THE  UNIVERSITY   PRESS,  CAMBRIDGE,  U.S.A. 


UNIVERSITY   I 


Editor  s   Preface 

IN  searching  for  physiological  wisdom 
relative  to  the  growth  and  care  of 
children^  I  was  greatly  interested  in 
securing  this  paper^  which  Professor 
Lafayette  B.  Mendel  of  the  Sheffield 
Scientific  School  of  Tale  University  pre- 
pared for  and  read  before  the  Mothers' 
Club  of  New  Haven^  Connecticut y  in 
October  last. 

It  is  by  an  eminently  careful  phys- 
iologist whose  specialty  tends  towards 
the  chemical  side  of  the  science ^  and  who 
is  unprejudiced  either  by  parentage  or 
tradition  in  his  estimate  of  the  subject 
of  Childhood  and  Growth. 


JG2829 


EDITOR'S    PREFACE 


No  other  introduction  is  necessary  to 
a  presentation  so  clear  and  fascinating 
as  this  is. 

I  have  begged  the  privilege  of  present- 
ing  this  charming  essay  to  the  public 
in  its  present  form, 

HORACE  FLETCHER. 


CHILDHOOD  AND  GROWTH 


^     OF  THE     ^ 


Childhood  and  Growth 

Jl  HE  problems  which  confront  the 
mothers  of  young  children  are  es- 
sentially physiological  in  character. 
The  infant  enters  the  world  in  an 
extremely  helpless  condition,  without 
adequate  control  of  its  muscles  and 
with  most  imperfect  organs  of  sense. 
It  is  deprived  of  the  assistance  and 
experience  which  we  derive  from 
these  important  groups  of  organs  in 
our  contact  with  the  things  about  us. 
Aside  from  what  is  acquired  through 
the  senses  of  taste  and  of  smell,  a  long 
period  intervenes  until  the  child  ob- 
tains any  adequate  impressions  of  its 


CHILDHOOD   AND   GROWTH 

environment  or  any  appropriate  and 
helpful  appreciation  of  the  relation 
which  it  sustains  to  its  surroundings. 
The  good  and  the  bad,  the  harmful 
or  the  harmless,  fail  to  be  recognized  ; 
or  if  they  are  indeed  appreciated,  the 
power  of  expressing  approval  or  dis- 
approval is  either  lacking  or  else 
manifested  by  signs  which  we  are 
unable  to  interpret  correctly  without 
the  greatest  difficulty.  Speech  is  still 
wanting  at  this  early  age,  and  the  child 
lacks  such  instincts  as  might  guide 
it  to  do  without  parental  care ;  ac- 
cordingly, observation  and  unceasing 
attention  must  supply  that  which 
nature  has  not  yet  provided.  Thus 
does  the  mother — the  caretaker,  the 


CHILDHOOD   AND   GROWTH 

nurse  —  become  responsible  for  the 
welfare  of  the  infant. 

I  have  recalled  these  facts,  so 
familiar  to  each  of  you,  in  order  to 
emphasize  at  the  outset  the  pre- 
eminent importance  of  physical 
factors  in  early  childhood.  In  a 
recent  paper  Dr.  Elizabeth  Campbell 
wrote : 

''  A  young  expectant  mother  is 
full  of  vagaries  ;  she  tries  to  think 
along  certain  lines,  such  as  poetry, 
music,  or  art,  in  order  that  her 
child  may  be  a  poet,  musician,  or 
artist ;  she  often  becomes  a  prey 
to  quackeries  of  all  kinds.  .  .  . 
A  very  few  straightforward  talks 
to  dissipate  her  vagaries  and  fears, 
injunctions  to  lead  a  natural  exist- 


CHILDHOOD   AND    GROWTH 

ence,  turning  her  attention  to  the 
fascinating  study  of  child  life  and 
its  limitless  possibilities,  teaching 
her  constantly  that  she  must  be 
ready  to  begin  the  training  of  her 
child  at  once  by  submitting,  with 
understanding,  to  the  regulations 
imposed,  will  secure  a  rhythmical 
habit  which  will  ripen  into  happy 
obedience."  ^ 

Mothers  as  individuals,  and  asso- 
ciations of  mothers,  are  ever  prone  to 
discuss  the  problems  which  especially 
concern  the  mind  and  the  soul  of  the 
child.  My  remarks  aim  to  present 
some  quite  different  aspects  of  growth 
in  childhood  which  seem  to  me  worthy 
of  more  careful  and  intelligent  con- 

1  <*  New  York  Medical  Journal,"  1905,  p.  581. 


CHILDHOOD    AND    GROWTH 

sideration  than  is  usually  accorded  to 
them. 

The  care  of  the  young  in  early 
infancy  is  by  no  means  a  simple  task  ; 
for  it  involves  a  period  of  profound 
physiological  changes  which  may  be 
of  momentous  significance  in  the 
later  life  of  the  individual.  The 
characteristic  function  of  the  body  in 
childhood  is  growth  —  essentially  a 
physiological  change,  into  the  char- 
acteristics of  which  we  must  inquire 
more  closely. 

The  physiologist  is  accustomed  to 
think  of  the  animal  body  as  a  ma- 
chine. Just  as  an  engine  transforms 
the  energy  appropriated  in  the  form 
of  fuel  into  useful  work  and  heat,  so 

13 


CHILDHOOD    AND    GROWTH 

the  body  mechanism  converts  the 
energy  of  its  fuel  —  the  food  we  eat 
—  into  muscular  activity  and  body 
warmth.  In  the  case  of  the  adult 
the  analogy  is  in  many  ways  a  far- 
reaching  one.  The  food  supply  must 
be  adapted  to  the  needs  of  the  body 
for  activity,  movement,  and  warmth. 
Work  calls  for  more  nutriment  than 
does  inactivity.  When  the  diet  is 
superabundant,  we  may  store  it  up 
and  put  on  flesh  ;  or  if  it  is  inadequate, 
we  may  burn  up  our  own  tissues  to 
supply  the  deficiency,  and  experience 
a  loss  of  body  weight.  The  demands 
of  the  body  for  appropriate  and  ade- 
quate fuel  are  satisfied  by  correct 
nutrition,  under  which  process  is  in- 

14 


CHILDHOOD   AND   GROWTH 

eluded  the  proper  preparation  of  the 
foodstuffs  for  utilization  —  in  other 
words,  digestion  —  as  well  as  the 
subsequent  elimination  of  the  waste 
products,  —  that  is,  the  function  of 
excretion.  There  are,  obviously,  in- 
cidents of  wear  and  tear  in  our  ma- 
chinery which  must  be  made  good 
by  the  nutritive  processes.  Such 
losses  in  the  adult  assume  no  signifi- 
cant proportions.  In  the  ymmg^ 
however,  the  additional  process  of 
growth  must  be  provided  for;  abd 
nutrition  here  plays  a  novel  role  in 
"supplymg  the  material  for  the  build- 
^iag  up  of  new  LlssueTlbesidesjriaking 
provision  for  theenergy  devoted  to 
muscular  activity  and  warmth. 

15 


CHILDHOOD   AND    GROWTH 

The  relatively  large  demands  of 
children  for  nutriment,  especially  at 
the  periods  of  most  active  develop- 
ment, no  longer  surprise  us  when  we 
recall  that  the  food  materials  are  re- 
quired for  growth  in  addition  to  the 
maintenance  of  the  ordinary  body 
functions.  But  I  believe  that  the 
popular  impression  regarding  th^  pro- 
portion of  the  food  intake  of  children 
oevoted  to  purposes  of  growth  is 
greattyyexaggerated.  A  boy  of  fif- 
teen, —  at  a  period  of^ very  vigorous 
"growth,  —  for  example,  will  consume 
about  1800  grams  (solids  and  liquids) 
per  day,  with  an  average  increase  of 
only  20  grams  in  body  weightf  simi- 
larly, a  girl  of  thirteen  years  consum- 

16 


CHILDHOOD    AND    GROWTH 

ing  1500  grams  daily  will  add  an 
average  of  12  grams  only  to  her 
weight  each  day.  The  portion  of  the 
substance  actually  stored  up  each  day 
—  scarcely  more  than  yj^  of  the 
intake  —  is  quite  small  in  itself  and 
cannot  be  the  immediate  cause  of  the 
large  demand  for  food  and  drink. 
On  the  contrary,  the  growing  child 
gxcretes  the  greater  part  of  its  ingested 
nutrients  inthe  form  of  waste  prod- 
ucts.  The  nutritive  demands  are 
large  because  all  of  the  chemicaT 
activities  of  the  body  are  heightened 
at  this  age.  The  intensification  of  the 
nutritive  exchanges  in  the  young  is 
an  mteresting  fact,  although  its  causes 
are  still  obscure. 

17 


CHILDHOOD    AND    GROWTH 

Every  proud  mother  —  and  I  pre- 
sume that  all  mothers  are  instinc- 
tively proud  of  their  children  —  is 
familiar  with  the  average  absolute 
gains  of  infants  in  body  weight. 
Thus  an  average  baby  will  gain 
about  an  ounce  a  day  during  the  first 
month,  and  continue  to  add  flesh. 
The  relative  daily  rate  of  growth, 
however,  is  quite  different  at  varying 
periods.  In  terms  of  the  total  weight 
of  the  child,  it  changes  approximately 
as  follows : 

1  The  Relative  Daily  Gain  of  Children 

In  the  first  month  it  is  about    .  '•00%  of  the  body  weight 

At  the  middle  of  the  first  year  0.3   %     "        "        *< 

At  the  end  of  first  year       .      .  0.15%     "         "        <* 

At  the  fifth  year      ....  0.03%     "        "       " 

1  The  figures  are  taken  fi-om  Camcrer. 


CHILDHOOD    AND    GROWTH 

Increasing  to  a  Maximum  of 

In  boys 0.07%  of  the  body  weight 

In  girls 0.04%     "        "        " 

*        *         ^  *        -x- 
In   the  calf  the  corresponding 

figure  for  the  first  week  is    .  5%  of  the  body  weight 

I  desire  to  point  out  that  in  animals 
the  relative  rate  of  growth  is  usually 
much  larger  than  that  of  children, 
amounting,  as  noted  above  in  the  case 
of  the  calf,  for  example,  to  as  much 
as  5  per  cent.  The  significance  of 
this  will  be  referred  to  later. 

With  the  pre-eminent  importance 
of  the  nutritive  processes  for  the 
growing  child  duly  impressed  upon 
us,  we  naturally  stop  to  inquire  what 
is  the  equipment  of  the  young  body 
for  the  physiological  work  it  has  to 

19 


CHILDHOOD    AND    GROWTH 

do.  Here  too,  at  early  ages,  we  find 
different  "degrees  of  readiness"  in 
different  animal  species  in  regard  to 
their  ability  to  perform  the  functions 
peculiar  to  the  fully  developed  indi- 
vidual. In  a  general  way  this  is  illus- 
trated by  the  varying  ability  to  get 
along  —  to  obtain  and  prepare  food 
independently  of  the  parent.  Fre- 
quently adequate  digestive  powers 
are  not  matured  at  birth,  and  more 
often  the  heat-regulating  mechanism 
is  imperfectly  developed  at  this  stage. 
Such  deficiencies  are  present  in  those 
animals,  like  birds,  which  hatch  from 
the  egg  and  have  an  extra-uterine 
development,  as  well  as  in  those 
which  attain  growth  in  closer  relation 


CHILDHOOD    AND    GROWTH 

to  the  mother.  This  "unprepared- 
ness  "  of  the  newly  born  for  an  in- 
dependent existence  is  interestingly 
exemplified  in  the  inability  of  the 
young  child,  as  well  as  the  chick 
or  the  mouse  or  the  kitten,  to 
maintain  its  body  temperature  per- 
fectly. You  are  quite  familiar  with 
the  fact  that  owing  to  the  peculiar 
nervous  regulating  mechanism  with 
which  the  organism  is  endowed  the 
body  temperature  of  an  adult  is  re- 
markably constant  despite  varying 
external  conditions.  Any  marked 
deviation  from  the  so-called  normal 
temperature  of  man  constitutes  a 
familiar  symptom  of  disease.  When 
newly   born  puppies,  kittens,   and 


CHILDHOOD    AND    GROWTH 

rabbits  are  removed  from  their  usual 
warm  surroundings,  their  tempera- 
ture will  become  lowered  and  con- 
tinue to  fall  until  it  reaches  a  point 
a  few  degrees  above  the  temperature 
of  the  surrounding  air.  These  ani- 
mals are  blind  at  birth,  helpless,  and 
in  some  cases  naked;  and  they 
cannot  maintain  their  temperature 
without  the  protective  warmth  and 
instinctive  huddling  together  afforded 
by  the  mother.  In  contrast  with 
such  animals  are  newly  born  guinea- 
pigs.  They  come  into  the  world  in 
a  condition  of  marked  development; 
the  animals  are  active,  their  eyes  are 
open,  they  have  a  partial  coat  of  fur, 
and  can  be  largely  independent  of  the 


CHILDHOOD    AND    GROWTH 

mother  in  procuring  food.  From  the 
earliest  period  these  animals  can  main- 
tain a  fairly  constant  temperature  amid 
colder  surroundings.  In  human  in- 
fants the  conditions  correspond  with 
those  pertaining  in  young  animals  of 
the  more  dependent  class  rather  than 
those  born  in  an  advanced  condition 
of  development.  The  infantile  tem- 
perature is  variable,  owing  to  the  im- 
perfect development  of  the  regulating 
power,  notably  in  immature  young 
individuals.  The  readiness  with 
which  the  temperature  irregularities 
manifest  themselves  upon  slight  prov- 
ocation, even  in  children  of  several 
years'  growth,  is  familiar  to  every 
observing  mother. 

23 


CHILDHOOD   AND    GROWTH 

It  remains  for  us,  therefore,  to 
draw  the  proper  lesson  from  this 
defenceless  condition  of  the  young 
amid  their  colder  environment.  We 
learn  to  appreciate  what  warm  cloth- 
ing means  to  the  naked  infant  other- 
wise helpless  in  its  resistance  to  the 
atmosphere  about  it.  I  am  ready  to 
believe  that  not  a  little  abdominal 
pain  and  crying  among  infants  is  ul- 
timately attributable  to  the  thought- 
less exposure  of  arms  and  legs,  even 
in  summer  months.  The  misguided 
judgment  or  unconcealed  convenience 
of  mothers  occasionally  permits  chil- 
dren to  cry  until  they  are  hoarse.  This 
is  neither  health-giving  nor  humane ; 
and    the    smallest    attention    to    the 

24 


CHILDHOOD   AND    GROWTH 

details  just  discussed  will  frequently 
restore  a  restful  quiet.  The  invigor- 
ating thrill  which  cold  in  the  form 
of  a  cold  bath  or  a  cold  sleeping- 
room  arouses  in  an  adult  is  scarcely- 
attained  at  those  ages  where  the 
temperature-regulating  mechanism  is 
not  yet  thoroughly  developed  for  the 
appropriate  response  of  heat  produc- 
tion. And  therefore  I  am  inclined 
to  believe  that  the  prevalent  practice 
—  shall  I  call  it  a  fad  ?  —  of  dressing 
young  boys  and  girls  in  short  socks 
at  certain  seasons  is  inadvisable,  if 
not  actually  barbarous.  Man  has 
instinctively  protected  himself  against 
the  unpleasantness  of  a  cold  environ- 
ment  by  the   adoption   of  clothing. 

»5 


CHILDHOOD   AND    GROWTH 

The  extent  of  this  protection  is  varied 
with  the  climate  in  which  he  resides. 
In  our  average  climate  about  80 
per  cent  of  the  body  is  ordinarily 
clothed.  The  bared-leg  costumes  of 
the  present  mode  may  leave  as  much 
as  30  per  cent  to  40  per  cent  of  the 
child's  body  surface  exposed  with  cor- 
respondingly increased  loss  of  heat. 
Some  of  us  have  noticed  that  even 
in  adults  the  kiltie  suit  may  become 
uncomfortably  cool  on  a  New  Haven 
summer  day  !  What  shall  we  expect 
in  the  less  resistant  child  during  cool 
autumn  weather  ? 

Turning  again  to  the  question  of 
nutrition,  I  may  remind  you  that 
the  child,  like  the  adult,  requires  the 

26 


CHILDHOOD   AND    GROWTH 

three  typical  groups  of  foodstuffs : 
the  proteids  (such  as  the  casein  of 
milk,  the  white  of  egg,  or  the  sub- 

Stance  of  meat)  to  build  the  tissues; 

. — . 7  '^ 

carbohydrate  foods  (like  the  sugars 
and  starches)  and  fats  to  furnish 
energy.  The  relative  proportions  in 
which  they  ordinarily  participate  in 
the  diet  is  indicated  below : 

Proportion    of   the   Energy   Intake    Con- 
tributed BY  THE  Different  Groups 
OF  Nutrients  in  Infancy 

Proteids 19% 

Carbohydrates 28% 

Fats 53% 

100% 

Eggs  and  milk  are  ideal  foods 
in  the  sense  that  they  contain  prac- 
tically all  of  the  food  elements  es- 

27 


CHILDHOOD    AND    GROWTH 

sential  to  the  young  whose  growth 
they  are  intended  to  support.  But 
nature  has  done  even  more ;  she  has 
adapted  the  milk  of  every  species  to 
the  special  needs  of  its  young,  as 
has  been  admirably  demonstrated  by 
Professor  Bunge. 

In  the  table  below  it  will  be  noted 
that  the  richness  of  milk  in  proteid, 
inorganic  salts,  lime  and  phosphoric 
acid  —  substances  needed  to  build 
the  tissues  and  bony  skeleton  —  is 
proportioned  to  the  rate  of  growth. 
Thus  the  food  supply  of  the  rapidly 
developing  puppy  is  comparatively 
more  abundant  in  the  necessary  con- 
stituents than  is  the  milk  furnished 
to  the  slowly  growing  infant. 

28 


CHILDHOOD    AND    GROWTH 


Time 

One  Hundred  Parts  or 

in  which  the 
body  weight 
of  the  newly 
born  animals 
is  doubled 

Milk  CoNTAih 

r 

Speciss 

"3 
*« 

S 

V 

E 

•;3 

0U, 

Man  .   .   . 

1 80  days 

1.6 

0.2 

0.32 

0.47 

Horse 

60    ** 

2.0 

0.4 

1.24 

1. 31 

Cow  . 

47    " 

3-5 

0.7 

1.60 

1.97 

Goat. 

19    ** 

4-3 

0.8 

2.10 

3.22 

Pig    . 

18    <* 

5-9 

.  .  . 

.  .  . 

Sheep 

10    " 

6.5 

0.9 

2.72 

4.12 

Dog  . 

8    *< 

7.1 

1-3 

4.53 

4-93 

Cat    . 

7    " 

9-5 

•    • 

It  is  a  further  remarkable  fact  that 
the  proportion  of  the  various  inor- 
ganic substances  (the  salts  or  mineral 
nutrients  as  they  are  sometimes  called) 
to  each  other  in  milk  is  almost  the 
same  as  it  is  in  the  entire  body  of 
the    animals  which    thrive    upon    it. 


29 


CHILDHOOD    AND    GROWTH 

The  relative  demands  of  the  grow- 
ing organism  for  more  lime  than 
magnesium,  more  phosphorus  than 
iron,  etc.,  is  thus  provided  for. 

Mineral  Constituents  of  One  Hundred 
Parts  of 


Sucking 

Dog's 

Dog's 

Puppy 

Milk 

Blood 

Potassium,  KgO     .    . 

8.5 

10.7 

3.1 

Sodium,  NagO    .   .    . 

8.2 

6.1 

45.6 

Calcium,  CaO    .   .   . 

35.8 

34-4 

0.9 

Magnesium,  MgO.   . 

1.6 

1-5 

0.4 

Iron,  FegOg     .... 

0-34 

0.14 

9-4 

Phosphorus,  PgO^  .    . 

39.8 

37-5 

13.3 

Chlorine,  CI    ...  . 

7.3 

12.5 

35.6 

These  small  quantities  of  the  inor- 
ganic constituents  of  milk,  insignifi- 
cant though  they  seem,  are  yet  most 
potent  in  their  influence  upon  growth 
and  nutrition.     Every  one  recognizes 


30 


CHILDHOOD    AND    GROWTH 

the  need  of  iron  for  the  blood,  of 
lime  for  the  bones;  but  too  often 
the  importance  of  the  others  is  over- 
looked. Thus,  without  common  salt 
(chloride  of  sodium)  no  normal  gastric 
juice  can  be  formed. 

In  the  table  following,  the  figures 
for  the  composition  of  the  milk  of 
several  animal  species  of  domestic 
importance  are  placed  together  for 
comparison. 


Composition  of  the  Milk  of  Various  Species 

(Percentages) 


Woman 

Cow 

Goat 

Mare 

Ass 

Pig 

Total  Proteids 

io7 

3.5 

4.3 

2.0 

2.2 

5.9 

Fat     .     .     o 

3.4 

3-7 

4.8 

Io2 

1.6 

6.9 

Sugar .      .      0 

6.1 

4-9 

4-5    . 

5.7 

6.0 

3.8 

Mineral  Matter 

0.2 

0.7 

0.8 

0.4 

0.5 

I  I 

31 


CHILDHOOD    AND    GROWTH 

After  what  has  been  said  you  will  ap- 
preciate, if  never  before,  why  mother's 
milk  cannot  be  replaced  by  that  of  the 
cow  —  least  of  all  by  proprietary  foods 
of  unsatisfactory  or  irrational  compo- 
sition. Our  imitations  are  poor  in- 
deed, and  "the  steam  sterilizer  will 
never  replace  a  mother's  love  and 
attention."  Nevertheless,  when  ne- 
cessity or  preference  calls  for  some 
substitute  for  mother's  milk,  the  at- 
tempt must  be  made  to  approach  as 
nearly  as  possible  to  the  natural  diet 
of  the  infant.  A  glance  at  the  com- 
parative analyses  will  indicate  why 
attention  has  been  directed  in  recent 
years  to  the  use  of  mare's  and  ass's 
milk.      In  digestibility  and  composi- 

3» 


CHILDHOOD   AND    GROWTH 

tion  they  seem  to  resemble  mother's 
milk  somewhat  more  closely  than 
does  cow's  milk ;  while  goat's  milk, 
contrary  to  the  current  belief,  is 
rather  closely  allied  to  that  of  the 
cow. 

In  addition  to  these  details  of  com- 
position pertaining  to  the  use  of 
foreign  milk,  there  is  the  further  fact 
that  children  are  accustomed  to  get 
food  far  more  easily  from  the  bottle 
than  from  the  breast,  and  too  often 
they  become  the  recipient  of  an 
undue  quantity  of  the  artificial  food 
through  the  misguided  generosity 
of  the  sympathetic  mother  or  nurse. 
The  actual  capacity  of  the  infan- 
tile  stomach   at   various    periods   is 

33 


CHILDHOOD    AND    GROWTH 

surprisingly  small  when  expressed 
in  absolute  figures.  According  to 
Rubner  it  ranges  as  follows: 

First  week 46  cc.     ( i  ^  ounces) 

Second  week 72  cc.     (2^  ounces) 

Second  month 140  cc.     (4%  ounces) 

Twelfth  month 400  cc.  (13^  ounces) 

The  problem  of  infant  nutrition 
is,  perhaps,  the  most  serious  one  con- 
nected with  the  physiology  of  child- 
hood, and  it  involves  primarily  the 
proper  adjustment  of  the  food  in 
quality  and  quantity  to  the  digestive 
capacity  of  the  young.  "  If  on  the 
one  hand  we  observe  how  carefully 
nature  has  adapted  the  composition 
of  the  milk  to  the  needs  of  every 
species  of  mammal,  and  if  on  the 
other  we  consider  how  ignorant  we 

34 


CHILDHOOD    AND    GROWTH 

are  concerning  the  nature  of  the  food- 
stuffs, the  digestive  processes  in  the 
infant  and  the  disturbances  which 
these  are  liable  to  from  the  myriad 
micro-organisms  in  the  intestines,  it 
is  not  a  matter  for  wonder  that  in 
spite  of  the  gravest  efforts  the  natural 
diet  for  infants  has  not  yet  been  suc- 
cessfully replaced  by  any  artificial 
food."  .  .  .  The  census  taken  in 
Berlin  in  1890  showed  that  there 
were  then  39,000  children  under  the 
age  of  one  year  in  that  city.  Of 
these  20,000  were  breast-fed,  16,000 
were  reared  by  hand.  Of  the  breast- 
fed children  one  in  thirteen  died, 
whereas  among  those  brought  up  by 
hand  the  mortality  rose  to  one  out 

35 


CHILDHOOD   AND    GROWTH 

of  every  two  infants.  ..."No  doubt 
this  exceessively  high  rate  of  infant 
mortality  is  due  not  only  to  the 
unnatural  mode  of  diet,  but  partly  to 
the  neglect  which  is  doubtless  in 
many  cases  associated  therewith ; 
since  a  mother  who  nurses  her  child 
would  also,  as  a  general  rule,  in- 
stinctively lavish  more  care  upon 
it."  —  [Bunge]  We  have  lived  to 
see  considerable  progress  made  in 
recent  years  in  the  artificial  nutrition 
of  the  young,  and  the  introduction 
of  accurate  "percentage  feeding" 
by  Professor  Rotch  marks  a  distinct 
advance  over  the  older  methods  of 
guesswork  and  trial.  To-day  the 
progressive  physician,  co-operating 

36 


CHILDHOOD    AND    GROWTH 

with  the  intelligent  mother,  is  in  a 
position  to  ascertain  whether  the 
various  nutrients  fed  are  satisfac- 
torily utilized,  and  to  readjust  the 
composition  of  the  food  mixture  to 
meet  the  requirements  of  the  indi- 
vidual case.  If  the  fats  or  the  pro- 
teids  are  incompletely  digested,  the 
proportion  of  either  can  be  modified 
without  any  extensive  change  in  the 
remaining  constituents.  We  are  thus 
attempting  precisely  what  nature  ac- 
complishes by  varying  the  composi- 
tion of  the  milk  at  different  intervals 
during  the  period  of  lactation.  The 
composition  of  the  milk  changes  in 
accordance  with  the  rate  of  growth ; 
just  as  the  suckling  grows  most  vig- 

37 


CHILDHOOD    AND    GROWTH 

orously  soon  after  birth  and  increases 
in  weight  less   rapidly  as   time  goes 
on,  so   the   amount    of  proteid  and 
Vnineral  ingredients^  in  the  milk  alsp^ 
aTTrrtTTisTies   with    the   duration  of 


lactation. 

The  most  progressive  clinicians 
agree  in  attributing  no  small  share 
of  the  digestive  disturbances  of  in- 
fancy to  overfeeding.  If  we  bear  in 
mind  the  more  tardy  digestibility  of 
cow's  milk,  and  the  attendant  danger 
of  a  decomposition  of  the  unabsorbed 
residues,  with  a  consequent  distribu- 
tion of  poisonous  products  in  the  or- 
ganism, the  train  of  difficulties  which 
attend  indiscretions  in  feeding  is 
apparent.     The  possibility  of  under- 

38 


CHILDHOOD    AND    GROWTH 

feeding  is  usually  overfeared.  It  is 
infinitely  better  to  lose  a  pound  or 
two  already  gained  than  to  endanger 
the  entire  organism  with  food  which 


cannot  be  assimilated.     An  ounce  re- 


tained is  worth  a  pound  regurgitated. 
It  has  often  seemed  to  me  that 
many  parents  display  an  excessive 
zeal  in  foisting  improper  diets  upon 
their  children.  They  fail  to  realize 
the  comparative  limitations  of  the 
youthful  digestive  tract,  while  the 
children  too  soon  learn  to  imitate 
the  customs  of  their  elders.  This 
is  true,  for  example,  in  the  habit  of 
eating  meat,  a  stimulating  and  con- 
centrated proteid  food.  "The  colt 
or  calf  does  not  thrive  on  a  diet  of 

39 


CHILDHOOD   AND    GROWTH 

rich  corn  meal,  though  it  may  be 
very  proper  for  the  horse  or  cow. 
Carnivorous  animals,  be  it  noted,  do 
not  allow  their  young  to  have  meat 
until  quite  a  time  after  they  have  all 
their  teeth  fully  developed,  though 
apparently  it  would  be  their  proper 
food.  Meat  given  to  kittens  or 
puppies  invariably  produces  convul- 
sions." ^  It  is  said  that  cats  will 
take  away  meat  from  their  kittens 
when  it  is  given  to  them,  even  up 
to  the  time  when  they  are  three 
months  old.  In  early  infancy  there 
is  only  imperfect  provision  for  the 
digestion  of  starch  ;  yet  I  could  name 

1  Hoy  :   "Eating  and  Drinking,"  p.  252. 
40 


CHILDHOOD    AND    GROWTH 

familiar  so-called  substitutes  for 
mother's  milk  which  abound  in  this 
foodstuff. 

The  intestine  of  the  young  is  ex- 
tremely delicate  and  far  more  liable 
to  bacterial  invasion  than  is  the  case 
in  later  life.  This  explains  in  part 
the  easy  susceptibility  of  children  to 
intestinal  infections ;  they  succumb 
under  conditions  in  which  the  adult 
is  thoroughly  immune.  Hence  has 
arisen  the  desire  to  protect  the  ali- 
mentary tract  against  the  introduction 
of  undesirable  organisms.  There  are 
unfortunately  two  erroneous  impres- 
sions regarding  the  efficacy  of  the 
sterilization  or  pasteurization  of  food, 

41 


CHILDHOOD   AND    GROWTH 

which  are  not  yet  completely  eradi- 
cated. The  one  assumes  that  the 
food,  once  sterile,  will  remain  so, 
and  disregards  the  danger  of  a  sub- 
sequent exposure.  The  other,  more 
serious  mistake  lies  in  the  belief  that 
in  destroying  germs  the  products  of 
their  previous  activity  are  likewise 
eliminated.  Milk  once  contaminated 
for  any  length  of  time  can  never 
be  rendered  wholesome  by  ever  so 
thorough  sterilization.  The  bacte- 
rial poisons  are  there  to  stay;  ac- 
cordingly, the  precious  food  should 
be  guarded  against  deterioration  from 
the  very  beginning.  Clean,  fresh, 
carefully  kept  milk  is  a  desideratum ; 

4» 


CHILDHOOD   AND   GROWTH 

sterilization  is  at  best  a  necessary 
evil :  worst  of  all  is  the  introduction 
of  the  so-called  harmless  preserva- 
tives which  place  a  premium  upon 
dirt  by  rendering  cleanliness  unnec- 
essary instead  of  unavoidable. 

I  have  already  referred  to  the 
peculiar  importance  of  the  mineral 
nutrients  for  the  proper  development 
of  the  body,  in  illustration  of  which 
the  familiar  need  of  lime  for  the 
growth  of  the  bones  was  mentioned. 
The  figures,  arranged  in  the  table 
according  to  the  ratio  of  lime  con- 
tained, indicate  how  unlike  is  the  dis- 
tribution of  mineral  ingredients  in 
different  common  foods. 

43 


CHILDHOOD    AND    GROWTH 

Analyses  of  Mineral  Ingredients  of  Various 
Articles  of  Diet 

Arranged  according  to  the  ratio  of  Lime  contained 


o 

go 
5^ 

IS 

go 

1 

0   0 

go. 

a 

cu 

S 

cu 

y 

Beef.   .   .   . 

1.66 

0.32 

0.029 

0.152 

0.02 

1.83 

0.28 

Wheat  .   .   . 

0.62 

0.06 

0.065 

0.24 

0.026 

0.94 

(0 

Potato    .   .   . 

2.28 

0.1 1 

O.I 

0.19 

0.042 

0.64 

0.13 

Egg  albumin 

1.44 

1.45 

0.13 

0.13 

0.026 

0.2 

1.32 

Peas   .... 

1. 13 

0.03 

0.137 

0.22 

0.024 

0.99 

(0 

Human  milk 

0.58 

0.17 

0.243 

0.05 

0.003 

0.35 

0.32 

Yolk  of  egg 

0.27 

0.17 

0.38 

0.06 

0.04 

1.9 

0.35 

Cow*smilk  . 

1.67 

1.05 

1. 51 

0.20 

0.003 

1.86 

1.6 

Notice  that  a  child  would  probably 
not  obtain  the  lime  requisite  for  the 
growth  of  its  frame  if  brought  up 
upon  meat  and  wheat  bread  alone. 
Professor    Bunge    has    lately    called 


44 


CHILDHOOD    AND    GROWTH 

attention  to  the  possible  danger  to 
children  in  the  increased  consump- 
tion of  candy,  prepared  as  it  is  from 
pure  sugar.  He  explains  the  popular 
notion  regarding  a  connection  be- 
tween defective  teeth  and  candy  eat- 
ing on  the  assumption  that  children 
who  live  largely  on  meat,  bread,  and 
candy — all  poor  in  lime  —  may  fail 
to  get  their  proper  quota  of  this 
element.  He  urges  a  return  to  lime- 
containing  sweet  fruits  for  the  dietary 
of  children.  This  seems  to  me  more 
rational,  at  least,  than  the  indiscrim- 
inate administration  of  lime-water. 
The  quantities  of  lime  in  common 
foods  are  given  in  the  table  following: 

45 


CHILDHOOD    AND    GROWTH 
Quantities  of  Lime  in  Foods 

(Milligrams  per  joo  grams  of  the  dry  substance^ 


Sugar    .     .     . 

o.o 

Egg  white      . 

130.0 

Honey  .      .      . 

6.7 

Peas    .     .     . 

137.0 

Beef     .      .      . 

29.0 

Plums      .     . 

166.0 

Wheat  bread    . 

46.0 

Human  milk 

243.0 

Grapes  (Malaga) 

60.0 

Egg-yolk .     . 

380.0 

Graham  bread . 

77.0 

Figs    .     .     . 

400.0 

Pears     .     .      . 

95.0 

Strawberries   . 

483.0 

Potatoes     .     . 

lOO.O 

Cow's  milk   . 

1510.0 

Dates    .      .      . 

108.0 

We  frequently  hear  the  remark 
that  childhood  is  the  period  at  which 
correct  habits  should  be  formed.  The 
subject  is  one  which  perhaps  more 
properly  belongs  to  the  psychology 
of  youth ;  but  the  foundation  of 
proper  habits  of  rest,  exercise,  and 
diet  should  be  based  upon  sound 
physiological    grounds.       Life    is    in 


46 


CHILDHOOD   AND    GROWTH 

a  sense  a  rhythm  of  inherited  or  ac- 
quired habits.  With  respect  to  one 
of  these  I  cannot  refrain  from  quot- 
ing Dr.  Nathan  Oppenheim.  He 
says : 

''  From  the  earliest  possible  time 
the  habit  of  eating  slowly  and 
chewing  the  food  very  thoroughly 
must  be  insisted  upon.  If  this  is 
begun  at  an  early  enough  age,  it 
is  easily  learned  and  will  prove  to 
be  a  valuable  acquisition  for  later 
years.  If  the  child  eats  with  an 
attendant  or  with  the  rest  of  the 
family,  he  should  be  allowed  to 
talk  to  a  reasonable  extent ;  speech 
should  be  regulated,  not  forbidden. 
For  with  children,  as  well  as  adults, 
the  act  of  speaking  causes  useful 

47 


CHILDHOOD    AND    GROWTH 

breaks  in  the  steady  course  of  mas- 
ticating and  swallowing  food ;  it 
allows  the  gastric  contents  to  be 
well  mixed  with  the  secretions  of 
the  stomach,  and  at  the  same  time 
it  provides  an  atmosphere  of  rea- 
sonable enjoyment  that  a  child 
may  claim  as  well  as  his  elders. 
The  rule  that  children  should  be 
seen  and  not  heard  is  capable  of 
too  strict  an  interpretation  that 
lends  itself  very  readily  to  petty 
domestic  tyranny.  So  long  as 
there  is  a  reasonable  and  healthy 
discipline  in  the  household,  every 
child  should  be  allowed  to  talk,  to 
take  part  in  the  family  life,  to  feel 
that  he  is  an  integral  part  of  the 
home  circle,  and  to  realize  that  his 
words  —  even  if  they  be  not  heavy 
with  wisdom  —  will    receive    the 

48 


CHILDHOOD   AND    GROWTH 

consideration  and  attention  which 
abiding  love  and  a  mild  toleration 
dictate.  The  ordinary  child  whose 
environment  provides  suitable  ex- 
amples of  self-restraint  and  good 
manners  learns  in  a  surprisingly 
short  time  how  to  conduct  him- 
self within  sufficient  bounds  to  be 
reckoned  as  a  human  being,  and 
not  as  a  more  or  less  untamed 
animal." 

I  have  dwelt  upon  the  subject  of 
table-habits  because  physiologists  are 
just  beginning  to  understand  the 
real  significance  of  the  pleasure  of  the 
table  In  the  functions  of  digestion,  as 
well  as  In  the  broader  enjoyment  of 
life.  The  psychical  element  In  diges- 
tion cannot  be  overrated.     Fear,  sor- 

49 


CHILDHOOD    AND    GROWTH 

row,  anguish,  nausea,  may  promptly 
check  the  flow  of  the  digestive  juices; 
while  palate-tempting  dishes  and  the 
pleasure  of  the  meal,  with  a  congenial 
environment,  are  mighty  incentives 
to  the  production  of  active  digestive 
'  secretions.  A  scolding  mother  and 
a  sensitive  child  make  an  unhealthy 
dining-room  combination. 

Dr.  Elizabeth  Campbell  says: 

"  Very  rarely  we  find  a  mother 
or  nurse  too  liberal,  not  tempering 
theory  with  sound  judgmento  It 
is  then  we  realize  that  for  the  ac- 
complishment of  such  a  training  a 
mother  with  a  fine  instinct,  tem- 
pered by  desire  of  investigation, 
and  endowed  with  common  sense 
in  the  appreciation   of  theory,  is 

50 


CHILDHOOD   AND    GROWTH 

not  only  the  physician's  ally,  but  a 
teacher  from  whom  can  be  learned 
many  precious  truths." 

However,  "  many  a  conscien- 
tious mother  sighs  on  Sunday 
morning  when  she  realizes  that 
on  that  day  the  structure  of  habit 
she  has  so  carefully  reared  during 
the  week  will  be  ruthlessly  over- 
thrown if  it  happens  to  please  the 
father." 

The  guidance  of  the  young  in 
their  bodily  exercise  and  sports  calls 
for  no  specific  rules  in  contrast  with 
those  of  the  old,  unless  it  be  to  modify 
the  extent  of  their  exertions.  In  the 
formative  and  impressionable  period 
of  their  careers  attention  should  be 
devoted  more  often  than  it  is  to  the 


51 


CHILDHOOD    AND    GROWTH 

elimination  of  physical  defects.  They 
are,  frequently,  remediable  by  the 
desrelopment  of  muscular  power 
through  the  exercise  of  specific  parts, 
and  by  inducing  appropriate  growth 
in  plastic  tissues.  I  have  been  im- 
pressed with  the  possibilities  in  this 
direction  in  my  contact  with  young 
college  students.  Not  only  do  our 
modes  of  dress  for  children  lead  to 
the  malformation  of  parts  of  the  body 
like  the  feet,  but  the  current  fashions 
in  child  play  seem  to  me  to  cultivate 
the  exercise  of  the  arms  and  legs  too 
exclusively.  Weakness  in  the  ab- 
dominal muscles  is  an  undesirable 
defect.  The  juvenile  overalls  — 
dirt-proof  and    comfortable — are 

5^ 


CHILDHOOD   AND    GROWTH 

therefore  to  be  welcomed  if  they 
effect  a  transformation  of  the  modern 
soldier-like  play  of  children  into  the 
free-and-easy  sport  of  animals.  We 
must  not  relegate  tumbling  and  roll- 
ing and  climbing  and  jumping  to  the 
lost  arts. 


<*  Behold  the  child  among  his  new-born  blisses, 
A  six  years'  darling  of  a  pigmy  size  ! 
See  where  'mid  work  of  his  own  hands  he  lies, 
Fretted  by  sallies  of  his  mother' s  kisses. 
With  light  upon  him  from  his  father's  eyes. 
See  at  his  feet  some  little  plan  or  chart. 
Some  fragment  from  his  dream  of  human  life. 
Shaped  by  himself  with  newly  learned  art,  — 
A  wedding  or  a  festival, 
A  mourning  or  a  funeral ; 

And  this  hath  now  his  heart. 
And  unto  this  he  frames  his  song. 
Then  will  he  fit  his  tongue 


53 


CHILDHOOD    AND    GROWTH 

To  dialogues  of  business,  love,  or  strife  j 

But  it  will  not  be  long 

Ere  this  be  thrown  aside. 

And  with  new  joy  and  pride 
The  little  actor  cons  another  part, 
Filling  from  time  to  time  his  *  humorous  stage 
With  all  the  persons,  down  to  palsied  age. 
That  life  brings  with  her  in  her  equipage. 

As  if  his  whole  vocation 

Were  endless  imitation." 


54 


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